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Washington University Experience | NEOPLASMS (HEMATOLYMPHOID) | Lymphoma, secondary | 5A0 Case 5 History
Case 5 History ---- The patient was a 67 year old right-handed woman with a past medical history significant for hypertension and non-Hodgkin's lymphoma diagnosed in November 2004. She is status post small bowel obstruction and resection, who began chemotherapy in December of 2005 and has since had multiple hospitalizations with mental status changes. She presented in 5/2005 to BJH with progressive encephalopathy and was found to have metastatic disease to the brain. Soon after additional rescue chemotherapy and discharge, she was readmitted 6/2005 with pneumonia. Neurologically, the patient deteriorated to the point that she was able to regard intermittently with eye opening to noxious stimuli, a partial left VI palsy, and motor withdrawal of all four extremities. MRI examination on June 2005 revealed and an enlarging posterior fossa mass with a complete obliteration of the forth ventricle and cerebral aqueduct, and severe obstructive hydrocephalus. In addition to the associated transependymal edema and left cerebellar edema, there were two nodular enhancing lesions, one adjacent to the frontal horn of the left lateral ventricle, and a smaller lesion on the right posterior to the third ventricle, consistent with metastatic lymphoma. An emergent right frontal ventriculostomy was placed on 6/30. Subsequently, she developed intraparenchymal hemorrhage along the tract of the shunt by CT 7/5 with associated intraventricular hemorrhage in the left lateral ventricle and expired on 7/8. ---- At autopsy the weight of the unfixed brain was 1350g.
